Into focus: Gaining insight into the prevalence, context, and prevention of violent victimization and revictimization among depressed patients

Psychiatric patients are at increased risk to fall victim to violence, which is called “victimization”. Although most studies have focused on patients with psychotic disorders or substance use disorders, research has demonstrated depressed patients to be at risk of (re)victimization as well. However, the highly scarce research has left many important questions unanswered. In the first part of this thesis, we describe our results regarding the prevalence, context, and correlates of (re)victimization in three separate populations with depressive disorders and other mental disorders. Chapter 2: In a large, representative sample of the general population (N = 5303), we demonstrated that, out of a wide range of common mental disorders, only alcohol dependence prospectively predicted violent victimization three years later after adjustment for childhood trauma. Furthermore, major depressive disorder, panic disorder, social phobia, generalized anxiety disorder, and alcohol dependence predicted future psychological victimization. Chapter 3: We compared the prevalence of violent victimization in remitted, formerly depressed patients (N = 140), currently depressed patients (N = 102), and a large, weighted sample of the Dutch general population (N = 9175). We demonstrated that 12-month prevalence rates of violent victimization among remitted patients were similar (12.1%) to those of the general population (11.7%), and lower than those of currently depressed patients (35.5%). Chapter 4 explored the context (e.g., perpetrator, location), gender differences, predictors, and disclosure rates regarding victimization among recently victimized depressed patients (N = 153). The second part of this thesis explores the relationship between sexual victimization, emotion dysregulation, and risk perception, and describes the unique impact of three types of childhood abuse on depressive symptoms among 276 female college students. In Chapter 5, we found no significant relationships between sexual victimization, emotion dysregulation, and risk perception (i.e., the ability to perceive risk in potentially threatening situations). In Chapter 6, we showed that only childhood emotional abuse, contrary to childhood physical and sexual abuse, was independently associated with current depressive symptoms, emotion dysregulation, and interpersonal problems. The third part of this thesis describes the development of an innovative add-on internet-based emotion regulation training (iERT) and the evaluation of its effectiveness in reducing revictimization. Chapter 7 describes the study protocol of our multicenter randomized controlled trial that primarily aimed to evaluate the effectiveness of guided iERT added to treatment as usual (TAU) in reducing violent revictimization and depressive symptoms in previously victimized, depressed patients compared to TAU alone. In chapter 8, we presented the key results of our randomized controlled trial among 153 recently victimized, depressed patients. These results remain under embargo. The fourth part of this thesis (Chapter 9) presents the results of our systematic review and meta-analysis on the effectiveness of internet- and computer-based cognitive behavioral therapy (cCBT) in adolescents and young adults aged 12-25 years with depressive and anxiety disorders. We concluded that cCBT is effective in treating depressive symptoms and anxiety symptoms compared to passive controls. Furthermore, we demonstrated that cCBT yields similar effects on anxiety symptoms as active treatment controls. For depressive symptoms, results remain inconclusive. The findings presented in this thesis lead to several recommendations for clinical practice, policy making, and future research. Among other recommendations, we strongly advocate the implementation of routine enquiry of childhood and adult victimization in clinical practice and stress the urgent need for longitudinal research focused on 1) unraveling the longitudinal relationship between victimization and mental disorders; 2) identifying risk factors and treatment targets regarding violent and psychological victimization among psychiatric patients, including factors of all ecological system levels; and 3) developing and evaluating interventions to reduce risk for violent and psychological (re)victimization in depressed patients and other psychiatric patients.